Expandable surgical access port

Abstract

A method of accessing an internal portion of a patient including the steps of providing an access assembly including an outer frame, an inner member and a flexible member, inserting the inner member through an opening in tissue into a body of a patient with the flexible member extending proximally through the opening in tissue, moving at least a first portion or second portion of the outer member to a select unlocked spread position to enlarge the opening in tissue and the passageway through the flexible member, and subsequently moving the locking member to move the first and second engagement structures into a locking position to lock the first portion in the select spread position.

What is claimed is: 
     
       1. A method of accessing an internal portion of a patient comprising: providing an access assembly including: an outer frame positionable outside the patient and defining an opening therein, the outer frame including discrete first and second portions and a locking mechanism for locking the discrete first and second portions of the outer frame in one of a plurality of select expanded positions, at least one of the first and second other of the first and second portions to adjust the opening, the opening portions being movable with respect to the dimensioned to receive a surgical instrument therethrough;
 the locking mechanism including a first engagement structure on the first portion selectively engageable with a second engagement structure on the second portion, the locking mechanism being repositionable between a locked position, wherein the first and second engagement structures are engaged, and an unlocked position, wherein the first and second engagement structures are disengaged, the locking mechanism being biased toward the unlocked position, and a slidable member movable to reposition the locking mechanism from the unlocked position to the locked position to retain the first and second portions in a selected expanded position; 
 wherein the second engagement structure comprises a first soft material and a second material on opposing sides of the opening, 
 wherein the first engagement structure includes a first substantially rigid projecting member having a first ramped surface and a first sharp tip embeddable within the first soft material; 
 wherein the first engagement structure includes a second substantially rigid projecting member having a second ramped surface and a second sharp tip embeddable within the second soft material; 
 wherein the slidable member comprises a first and a second collars positioned around and slidable relative to the first and second portions of the outer frame, the first collar is capable of contacting the first ramped surface to pivot the first sharp tip into the first soft material, and the second collar is capable of contacting the second ramped surface to pivot the second sharp tip into the second soft material; 
 an inner member positionable within the patient; and 
 a flexible member extending between the inner member and the outer frame and operatively associated with the outer frame, the flexible member having a passageway to receive the surgical instrument therethrough, wherein movement of the first and second discrete portions of the outer frame adjusts tension on the flexible member to retract tissue; 
 inserting the inner member through an opening in tissue into a body of the patient with the flexible member extending proximally through the opening in tissue; 
 moving one of the first and second portions of the outer frame in relation to the other of the first and second portions into a selected unlocked spread position to enlarge the opening in tissue and the passageway through the flexible member; and 
 subsequently moving the locking mechanism to move the first and second engagement structures into a locking position to lock the first and second portions in the selected spread position. 
 
     
     
       2. The method of  claim 1 , further comprising introducing the surgical instrument through the opening in the outer frame and the passageway in the flexible member. 
     
     
       3. The method according to  claim 1 , wherein moving the locking mechanism includes moving the locking member with respect to the second portion. 
     
     
       4. The method of  claim 1 , wherein moving the locking mechanism to move the first and second engagement structures into the locking position includes camming the first and second engagement structures into engagement with first and second surfaces of the outer frame. 
     
     
       5. The method of  claim 1 , wherein moving at least one of the first and second portions includes sliding the first portion in a direction away from the second portion. 
     
     
       6. The method of  claim 1 , wherein moving the locking mechanism includes sliding the locking member toward the first portion. 
     
     
       7. The method of  claim 1 , further comprising inserting a specimen retrieval apparatus through the passageway in the flexible member. 
     
     
       8. The method of  claim 1 , wherein inserting the inner member includes folding the inner member for insertion through the tissue opening. 
     
     
       9. The method of  claim 1 , wherein inserting the inner member includes inserting the inner member into a thoracic cavity of the patient. 
     
     
       10. A method of accessing a thoracic cavity of a patient for performing minimally invasive thoracic surgery comprising:
 providing an access assembly including: 
 an outer frame defining an opening therein, the outer frame including discrete first and second portions relatively movable to adjust the opening and a locking mechanism for locking the discrete first and second portions of the outer frame in one of a plurality of select expanded positions, 
 the opening dimensioned to receive a surgical instrument therethrough to access the thoracic cavity, 
 the locking mechanism including a first engagement structure on the first portion selectively engageable with a second engagement structure on the second portion, the locking mechanism being repositionable between a locked position, wherein the first and second engagement structures are engaged, and an unlocked position, wherein the first and second engagement structures are disengaged, the locking mechanism being biased toward the unlocked position, and a slidable member movable to reposition the locking mechanism from the unlocked position to the locked position to retain the first and second portions in a selected expanded position; 
 wherein the second engagement structure comprises a first soft material and a second material on opposing sides of the opening, 
 wherein the first engagement structure includes a first substantially rigid projecting member having a first ramped surface and a first sharp tip embeddable within the first soft material; 
 wherein the first engagement structure includes a second substantially rigid projecting member having a second ramped surface and a second sharp tip embeddable within the second soft material; 
 wherein the slidable member comprises a first and a second collars positioned around and slidable relative to the first and second portions of the outer frame, the first collar is capable of contacting the first ramped surface to pivot the first sharp tip into the first soft material, and the second collar is capable of contacting the second ramped surface to pivot the second sham tip into the second soft material; 
 a flexible member extending distally from the outer frame, the flexible member having a passageway dimensioned to receive the surgical instrument therethrough to access the thoracic cavity; 
 moving at least one of the first and second portions of the outer flame to a selected unlocked spread position to enlarge the opening in tissue and the passageway through the flexible member; and 
 moving the locking member to move the first and second engagement structures into a locking position to lock the first and second portions of the outer flame in the selected spread position. 
 
     
     
       11. The method of  claim 10 , wherein the access assembly includes an inner member, the flexible member extending proximally from the inner member, and the method further includes inserting the inner member through the opening in tissue and intercostal space into the thoracic cavity of the patient with the flexible member extending proximally through the opening in tissue. 
     
     
       12. The method of  claim 10 , further comprising introducing the surgical instrument through the passageway into the thoracic cavity. 
     
     
       13. The method of  claim 10 , wherein moving the locking mechanism to move the first and second engagement structures into the locking position includes camming the first and second engagement structures into engagement with first and second surfaces on the first portion. 
     
     
       14. The method of  claim 13 , wherein moving at least one of the first and second portions includes sliding the first portion in a direction away from the second portion. 
     
     
       15. The method of  claim 14 , wherein moving the locking mechanism includes sliding the second portion toward the locking mechanism. 
     
     
       16. The method of  claim 10 , further comprising inserting a specimen retrieval apparatus through the passageway and into the thoracic cavity. 
     
     
       17. The method of  claim 11 , wherein inserting the inner member includes folding the inner member for insertion through the tissue opening. 
     
     
       18. The method of  claim 1 , wherein providing the access assembly includes providing the outer frame such that at least one of the first and second portions defines an internal space configured and dimensioned to slidably receive the other of the first and second portions to facilitate relative movement between the first and second portions. 
     
     
       19. The method of  claim 10 , wherein providing the access assembly includes providing the locking mechanism as a discrete component of the access assembly separate from the first and second portions of the outer frame. 
     
     
       20. The method of  claim 10 , wherein providing the access assembly includes providing the outer frame such that at least one of the first and second portions defines an internal space configured and dimensioned to slidably receive the other of the first and second portions to facilitate relative movement between the first and second portions. 
     
     
       21. The method of  claim 10 , wherein providing the access assembly includes providing the locking mechanism as a discrete component of the access assembly separate from the first and second portions of the outer frame.